Non-Hodgkin's Lymphoma - Chemotherapy

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Etoposide. Etoposide is another cancer drug that is sometimes used in a regimen called EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin.) EPOCH may be used in combination with rituximab.

Side Effects and Complications

Side effects and complications of any chemotherapeutic regimen are common. They are more severe with higher doses. Side effects may increase over the course of treatment. Radiation treatment may worsen chemotherapy side effects.

Common Side Effects. Common side effects include:

Nausea and vomiting -- Drugs known as serotonin antagonists, such as ondansetron (Zofran) or granisteron (Kyril), can relieve these side effects.

Diarrhea

Hair loss

Mouth sores

Weight loss

Depression

These side effects are nearly always temporary. Most patients are able to continue with normal activities for all but perhaps a few days a month.

Serious Side Effects. Serious chemotherapy side effects can also occur and may vary depending on the specific drugs used. They include:

Neutropenia is a severe drop in white blood cells. Neutropenia increases the chance for infection and is a potentially life-threatening condition. Drugs called granulocyte colony stimulating factor (G-CSF) are used to help boost white blood cell count. These drugs, which include filgrastim (Neupogen) and pegfilgrastim (Neulasta), can help lessen the risk for neutropenia occurrence and, if neutropenia does occur, to reduce its length and severity. Patients should also use lifestyle precautions to prevent infection. (See Transplantation section of this report.)

Anemia is a lack of red blood cells. Erythropoietin stimulates red blood cell (hemoglobin) production and can help reduce or prevent this side effect. It is available as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp). In patients with cancer, these drugs should be used to treat only anemia associated with chemotherapy and to increase hemoglobin levels to no more than 12 g/dL. Treatment should stop as soon as chemotherapy is complete. These drugs may not be safe or appropriate for all patients.

Liver and kidney damage

Abnormal blood clotting (thrombocytopenia)

Allergic reaction